In nearly a quarter of pediatric patients evaluated for sexual abuse or assault, a second exam turned up new information, researchers reported.

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In nearly a quarter of pediatric patients evaluated for sexual abuse or assault, a second exam turned up new information.

Note that a second exam turned up new evidence of sexually transmitted infection in 6.5% of abuse victims.

In nearly a quarter of pediatric patients evaluated for sexual abuse or assault, a second exam turned up new information, researchers reported.

In a retrospective analysis of more than 700 patients, a second exam turned up new evidence of sexually transmitted infection in 6.5% of abuse victims, according to Amy Gavril, MD, of the Ft. Belvoir Community Hospital in Ft. Belvoir, Va., and colleagues at the University of Texas Health Science Center in San Antonio.

And the second exam resulted in a change in the likelihood of trauma in 17.7%, Gavril and colleagues reported in the February issue of Pediatrics.

Overall, they reported, the second exam -- on average 34 days after the first -- yielded new information in 176 of 727 patients, or 23.4%.

The American Academy of Pediatrics suggests that a second exam can be part of treatment, but many clinicians are reluctant because of the belief that an anogenital exam is stressful, Gavril and colleagues noted.

As well, there is little information on the impact of subsequent exams on diagnosis and treatment, they added.

To help fill in the gap, they conducted a chart review of consecutive patients who had both an initial and follow-up sexual abuse examination on July 1, 2004 and Dec. 31, 2009 at two institutions in San Antonio.

Of the 727 patients, 632 (87%) were female and 317 (43.6%) were pre-adolescents, defined for this study as younger than 12.

Findings in the examinations were classified as positive if they were diagnostic of trauma or sexual contact and as normal or non-specific if they were not (such things as irritation or genital discharge).

When research has not clearly shown a finding to be diagnostic or normal -- such as a posterior deep notch of the hymen -- it was classified as indeterminate. Unclear or questionable findings were classified as unknown.

Overall, in the first exam, 435 patients (59.8%) had normal findings, 181 (24.9%) were positive, 31 (4.3%) were indeterminate, and 80 (11%) were unknown, the researchers reported.

In the second exam, more patients had normal findings -- 612 (84.2%) – because of healing over the interval, the researchers found. On the other hand, 77 (10.6%) remained or became positive, while 33 (4.5%) were indeterminate and five (0.7%) were unknown.

But the researchers found changes in the likelihood of trauma in 129 patients -- 82 of whom had a decrease in the likelihood of trauma and 47 an increase.

For example, several patients had non-specific findings that could be attributed to trauma but were found at follow up to be such things as hemangioma and nevus. They had a decrease in the likelihood of trauma.

However, one patient had a single sign of acute trauma at the first exam and several on the second exam, but denied sexual contact in the interim.

At the first exam, clinicians diagnosed 130 patients with sexually transmitted infections, most of them with a normal or nonspecific physical exam. At the second exam, another 47 cases were diagnosed, in many cases because signs and symptoms had not yet appeared at the first exam.

Changes both in the likelihood of trauma and detection of additional sexually transmitted infections were more likely in patients who were 12 or older, female, sexually active, or with a history of genital-genital contact or drug-facilitated sexual assault, the researchers found.

The researchers cautioned that the analysis only included patients who had both exams, most of whom were co-operative, so that the results may not apply to other groups.the impact of the follow-up exam on the emotional recovery of the patient was not known in this patient population.

The group stated that their results "strongly support" follow-up sexual abuse exams for the following patients:

Adolescent and sexually active females

Uncooperative patients

Females who disclose genital-to-genital contact with the perpetrator

Cases of drug-facilitated sexual assault

Patients with initial unknown or positive nonacute ﬁndings

The authors did not report external support for the study. They said they had no relevant financial relationships to disclose.